Stereotactic body radiotherapy vs radiofrequency ablation in the treatment of hepatocellular carcinoma: a meta-analysis

Abstract

Background Both stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) are effective local treatments for hepatocellular carcinoma (HCC), but whether RFA is superior to SBRT is still controversial. Therefore, we performed a meta-analysis to compare the treatment outcomes of SBRT with RFA as curable or bridge intention.Methods We searched online databases for studies that compared treatment outcome for SBRT and RFA. Eligibility criteria included evaluation of local control, overall survival (OS), transplant rate, and post-transplant pathological necrosis.Results 10 retrospective studies with a total of 2732 patients were included. 2 studies were in favor of SBRT in local control, 2 studies preferred RFA in OS and others reported comparable outcomes for both. SBRT demonstrated significantly higher 1- and 3-year local control than RFA (OR 0.42, 95% CI 0.24 to 0.74, P =0.003; OR 0.54, 95% CI 0.37 to 0.80, P =0.002, respectively). However, SBRT reported significantly shorter 1- and 2-year OS (OR 1.52, 95% CI 1.21 to 1.90, P =0.0003; OR 1.66, 95% CI 1.38 to 2.01, P <0.00001, respectively). As bridge treatment, no significant difference was shown in transplant rate and post-transplant pathological necrosis rate (OR 0.57, 95% CI 0.32 to 1.03, P =0.060; OR 0.49, 95% CI 0.13 to 1.82, P =0.290, respectively).Conclusions This study demonstrates SBRT is able to complete a better local control for HCC than RFA, though the OS is inferior to RFA because of tumor burden or liver profiles of the enrolled studies. Well-designed, randomized, multicenter trials will be required to further investigate the conclusion.

Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: Systematic review and meta‐analysis of propensity score studies

“…Prior to this study, there are two precedent meta-analyses comparing the OS between patients with liver malignancies. 23,24 In both metaanalyses, RFA was associated with better OS (HR, 1.43; 95% CI, 1.05-1.95; 23 and odds ratio, 1.43; 95% CI, 1.24-1.64 24 ). However, both meta-analyses referred to some insufficiently matched studies in which PS analysis was not carried out and did not mention matching on BCLC-factors.…”